Women and girls

Globally, among people living with HIV aged 15 years and older, coverage of antiretroviral therapy in 2018 was higher for women than for men. Numerous studies have shown that men are less likely than women to take an HIV test and to initiate and adhere to HIV treatment, which results in poorer clinical outcomes and a greater likelihood that they will die of AIDS-related causes. The low utilization of HIV services among men reflects general patterns of male health-seeking behaviour, which have been attributed to prevailing norms of masculinity, stigma, opportunity and other costs of attending health facilities, and inconveniently designed services (among other factors).

The disparity is seen across a range of geographic and epidemic settings. Regional estimates indicate that coverage of antiretroviral therapy was higher among women than men in all but one region with sex-disaggregated data. The disparity was most pronounced in western and central Africa, where an estimated 61% [32–67%] of women living with HIV were receiving HIV treatment in 2018, compared with 40% [18–41%] of their male peers. Treatment coverage for men and women differed by at least 10% in Asia and the Pacific, the Caribbean, eastern and central Africa, and eastern Europe and central Asia—trends that may reflect the fact that antenatal services have been a key entry point for HIV testing and treatment services in many regions.

Universal access to quality comprehensive sexuality education is crucial, especially for young people. It enables young people to make informed decisions and be empowered as they explore their sexuality and relationships. It helps them acquire the skills and values of mutual respect, tolerance, gender equality and non-violence, and it equips them with the knowledge they need to protect their health and well-being more effectively.

Levels of HIV knowledge vary across countries, depending on the national and local context, and they often are associated with social and economic inequities. In many countries, levels of comprehensive and correct knowledge of HIV among adolescent girls and women are low, but they tend to be lowest among those who live in poverty and those with lower levels of education. They also are lower among rural women than those in urban areas.

Nining Ivana, the local coordinator of the Indonesia Positive Women Network (IPPI), Jakarta, was shocked when she received a voice message from one of the network’s new members.

In the message, Mutiara Ayu (not her real name) said that she had been beaten by her husband and abused by her husband’s family when they discovered that both her and her son were living with HIV. Research by IPPI in 2011 found that, like Ms Ayu, more than 28% of its members across Indonesia had experienced violence from their partners and family members because of their HIV status. It is known that women who are victims of sexual abuse are also at a higher risk of contracting HIV.

To address the linkages between HIV and violence against women, IPPI is holding a series of workshops to better integrate services for HIV care, support and treatment and against violence against women across eight cities in Indonesia. IPPI members who are survivors of violence, local HIV service workers from public health clinics and managers of women’s shelters have been attending the workshops, at which the results of the IPPI’s research are disseminated, needs are discussed, experiences are shared and a local action plan to better integrate both services is decided upon.

“I heard stories from HIV service providers at public health clinics. They couldn’t understand how a woman living with HIV had such a low CD4 level despite routinely visiting the clinic. Apparently, her husband banned her from taking her antiretroviral medicine. They know that these women are more likely to be victims of violence, but they do not know where to refer them to, since there is no standard operating procedure beyond their health care,” said Chintya Novemi, the person in charge of integrating services for HIV and violence against women at IPPI.

In addition to HIV care, support and treatment services, women living with HIV who are victims of violence may need counselling for trauma and legal aid should they decide to pursue litigation. Through its HIV & Violence against Women Services Integration Project, IPPI aims to bridge this gap. When there is not a formal relationship or mechanism, or it is not clear, informal referral mechanisms made by local stakeholders could save a woman’s life.

“After meeting with workers from services for HIV and violence against women at the workshop, it became clearer to me where I should refer IPPI members who encountered violence and how we should handle their cases,” said Ms Ivana, who joined the workshop in Jakarta.

Upon finishing the series of workshops, IPPI hopes to disseminate the results to national stakeholders, including the National Commission on the Elimination of Violence against Women, the Ministry of Health, the Ministry of Law and Human Rights and others. The ultimate goals are to gather evidence regarding these interlinked issues and advocate for a national standardized mechanism to protect women living with HIV from all forms of gender-based violence. 

Between 1995 and 2018, the steepest decrease in new HIV infections among women occurred among adolescent girls and young women (aged 15 to 24 years)—a decline of 44% globally. Prevention programmes that focus on this age group are having an impact.

Nonetheless, in 2018, approximately 6000 adolescent girls and young women acquired HIV each week, and they accounted for 60% of the estimated 510 000 new HIV infections in that age group. In sub-Saharan Africa, gender-related factors fuelling the epidemic are especially stark: adolescent girls and young women were more than twice (2.4 times) as likely to acquire HIV than their male peers.

The world is still a long way from achieving the global target of reducing new HIV infections among adolescent girls and young women to fewer than 100 000 by 2020: in 2018, that number stood at 310 000, three times higher than the target.

“I was walking to work, like I do every morning. There was a man on a motorbike at the end of the street. As I walked pass him, he grabbed my breasts and sped off.” This is a quote from one of the many stories featured on Hollaback! Jakarta’s website.

Sexual harassment and other forms of gender-based violence remain a serious issue for women in Indonesia. According to the National Commission on Violence Against Women’s Annual Report, there were more than 400 000 reported cases of violence against women in 2019, of which 28% were in public spaces. Public facilities, public transport and streets have become places where women do not feel safe and secure.

Hollaback! Jakarta is part of the global movement to end harassment in public spaces. In its quest to create safer spaces for women in the city, Hollaback! Jakarta works with ride-hailing app companies, public transport services, schools and campuses to provide training on gender-based violence.

“By training motorbike taxi drivers, they are not only able to understand forms of harassment, but also take an active part in intervening against harassment they see in public spaces,” said Noval Auliady, Co-Director of Hollaback! Jakarta. In Jakarta, where streets are filled with motorbike taxis, this is incredibly important.

Currently, women do not have full legal protection from gender-based violence. While there are laws that exist, gaps still remain. The Draft Bill on the Elimination of Sexual Violence was set to fill the gap, with an expanded definition of sexual violence and a focus on protection and victim restitution.

For several weeks in September 2019, students, activists and young people took to the streets of major cities in Indonesia to demand the passing of the draft bill. Hollaback! Jakarta was part of the core team for the campaign, creating a social media buzz, mobilizing people and meeting with parliamentarians.

Unfortunately, the draft bill was not passed in the last parliamentary sitting as conservative groups strongly argued against the clauses on the criminalization of marital rape. It is notable that the bill is still included in this year’s priority list of the national legislation programme. The massive support from civil society groups for the bill does increase its likelihood of passing and brings hope to the fight for ending gender-based violence in Indonesia.

The Internet has become a great ally for the movement. Not only was social media vital in mobilizing people to support the draft bill, it has also been a powerful platform to spread the important message of ending violence against women.

On its website, Hollaback! Jakarta encourages people to share their stories, showing how widespread, serious and familiar experiences of violence are for women. Like the quote above, people share personal experiences and some share cases they have witnessed as bystanders.

The Hollaback! Jakarta website has posted more than 300 stories of women experiencing various forms of gender-based violence, from catcalling to abuse. With each story posted, others can show their solidarity by clicking “I’ve got your back”. With its website and social media presence, Hollaback! Jakarta recognizes the potential to create a virtual safe space for women experiencing such issues.

“The more stories there are, the more people are willing to speak up and show their support. More bystanders are willing to intervene when seeing it first-hand. This is what we hope to achieve,” said Mr Auliady.

People who use drugs are often highly stigmatized and face high levels of discrimination. Women who use drugs, however, are doubly stigmatized and discriminated against—because of their drug use and because of their gender. They are also more exposed to gender-based violence and human rights violations that put them at risk of HIV and other infections.

Worldwide, few harm reduction programmes tailor their services to meet the needs of women, and gender-based discrimination may make them unwelcoming. HIV-related services also often don’t cater for the needs of women who use drugs.

As part of efforts to reach out to women who inject drugs, the India HIV/AIDS Alliance is working with the Punjab Government, through its Ministry of Health and Family Welfare at the Civil Hospital in Kapurthala, to develop a comprehensive harm reduction model for women who inject drugs in Punjab.

The hospital is developing a holistic and person-centred approach through a harm reduction clinic that provides services tailored to meet the needs of women. Employing a one-stop shop approach, HIV and harm reduction services are present in one facility. Clients are provided with a range of options, including opioid substitution therapy, needle–syringe programmes and naloxone, an effective treatment for opioid drug overdoses, which they can access free of charge at a time that suits them the best.

“When we didn’t have our women’s harm reduction centre, accessing opioid substitution therapy from other centres was a real challenge. The male users harassed us for sexual favours,” said Preeti Singh (not her real name), a client of the clinic.

The clinic works in partnership with local nongovernmental organizations to ensure that women who inject drugs can access other services, including counselling, HIV testing and sexual and reproductive health services. A menu of gender-sensitive services has been developed that draws on experience from India and other Asian countries. Women are service providers, community mobilizers and beneficiaries of the project.

“Initially my husband and my in-laws did not allow me to go access opioid substitution therapy from the women’s harm reduction centre. Now that I am on antiretroviral therapy and healthier, they know it works!” said Kiran Sharma (not her real name), a client of the clinic.

The project is also focusing on the creation and strengthening of community forums, organized by the State Drug User Forum together with the India HIV/AIDS Alliance. The forums aim to gather information from the perspective of the women themselves, to understand and respond to cross-cutting issues, including gender-based violence and stigma and discrimination, as well as to strengthen the delivery of HIV and harm-reduction services.

“Like my peers, I also went to the centre for seeking help with my withdrawals, and I was surprised to find many services for girls like us. What I like most was that there was help to take care of my child,” said Monica David (not her real name), a client of the clinic.

Started in February 2019, the project has already attained its target of reaching 150 women who inject drugs. The clinic has had a dramatic impact on the women’s lives, improving awareness about HIV, hepatitis C and tuberculosis prevention and testing and linking them to further treatment and care based on their need.

The project will be assessed later in the year and the evidence used for introducing and scaling up the model in India and elsewhere in Asia.

The UNAIDS Country Director for India, Bilali Camara, said that the project is timely. “We must continue to work collectively to close the gaps that continue to leave behind women who use drugs. Ending the AIDS epidemic as a public threat by 2030 depends on advancing a social justice and inclusion agenda that demands access to integrated health services free from discrimination, with the meaningful involvement of the communities,” he said.

“For five years I have been subjected to harassment and threats—rape threats, murder threats, vilification, character assassination, phone calls to my family, to my mom,” said Lebanese television anchor Dima Sadek.

To raise public awareness about sexual harassment and bullying in Lebanon, particularly against female journalists during the recent protests, the Arab Foundation for Freedoms and Equality—UNAIDS’ regional partner on rights and health—has produced a video that sheds light on this human rights abuse committed against many women in the country.

Made in partnership with the HIVOS Women Empowered for Leadership (WE4L) programme, with funding from the Dutch Ministry of Foreign Affairs, the video highlights cases of harassment and assault—reporters whose bodily autonomy has been violated, whose personal telephone numbers have been leaked and who subsequently received rape threats and pornography and who have been verbally and physically attacked while live on television.

“You don’t expect that someone could be this hurtful or that they could say such things. You don’t know them and they don’t know you, but because you differ on politics, they feel they are allowed to talk to you in this way,” said Layal Saad, a reporter.

Since similar attacks, including online bullying and harassment both online and offline, have also been reported by female protesters, the video also seeks to raise awareness about the everyday sexual harassment, bullying and violence that women in general are subjected to, emphasizing the need for policies that allow women to become leaders.

Diana Moukalled, a journalist, explained that legal protection against sexual harassment is needed, since at present there are no laws that criminalize sexual harassment in Lebanon. “Lebanese women are among the most politically marginalized in the world, not just in the region. We see women present on many levels, yet there is a sharp discrepancy between the role of Lebanese women and their representation,” she said.

The video’s title is We Carry On, echoing the sentiment of the many women who watched and reacted to it—a feeling of resilience in the face of adversity and a determination to achieve the social justice demanded by women in Lebanon.

GENEVA, 28 February 2020—Women living with HIV around the world have been fighting for decades for the recognition of their sexual and reproductive health and rights, including their right to start a family and have children. However, over the years, there have been far too many examples of forced sterilizations and coerced abortions.

The sixty-fourth session of the Commission on the Status of Women will be held at the United Nations Headquarters in New York, United States of America, in March 2020 and will be a reminder that 25 years ago governments adopted the Beijing Declaration and Platform for Action. Governments agreed and committed to uphold the human rights of all women and to protect and preserve their sexual and reproductive health and rights.

Those rights include the right to start a family and have children, the right to decide the number and spacing of their children, the right to reproductive autonomy and the right to access quality services to support their reproductive health choices, based on their informed, safe and voluntary consent.

These are fundamental human rights that belong to all women, regardless of HIV status, and are guaranteed in global and regional treaties. In 2016, the United Nations General Assembly committed to ending forced sterilization, in particular the sterilization of women living with HIV, in the Political Declaration on Ending AIDS.

The South African Commission on Gender Equality’s report dated February 2020 reminds us of the need for reproductive justice for women living with HIV, and that we must be constantly vigilant for and responsive to violations.

UNAIDS acknowledges the report and its findings that women living with HIV have been subjected to forced and/or coerced sterilization. UNAIDS thanks the International Community of Women Living with HIV, and Her Rights Initiative for bringing the cases to the attention of the Commission and we commend the Commission for demanding a response. 

UNAIDS notes that South Africa recently launched its National Human Rights Plan to tackle human rights-related barriers to HIV and tuberculosis services and gender inequality in South Africa. UNAIDS and the United Nations family stands ready to fully support government, civil society and stakeholders in the roll-out of the plan.